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European Radiology

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01-10-2018 | Gastrointestinal

Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction

Authors: Camille Rondenet, Ingrid Millet, Lucie Corno, Isabelle Boulay-Coletta, Patrice Taourel, Marc Zins

Published in: European Radiology | Issue 10/2018

Abstract

Objectives

To identify computed tomography (CT) findings associated with bowel necrosis in patients with surgically confirmed strangulating closed-loop small-bowel obstruction (CL-SBO) due to adhesions or internal hernia.

Methods

This retrospective study was approved by our institutional review board, and informed consent was waived. To identify CT signs of bowel necrosis, two gastrointestinal radiologists performed blinded, independent, retrospective reviews of 41 CT studies from consecutive patients who had CL-SBO due to adhesions or internal hernias and who underwent surgery within 48 h. On the basis of surgical and pathological findings, patients were classified as having reversible ischemia or histologically documented necrosis. Univariate statistical analyses were performed to assess associations between CT signs and bowel necrosis. Kappa statistics were computed to assess interobserver agreement.

Results

We included 25 (61%) women and 16 (39%) men with a median age of 79 years. Bowel necrosis was found in 25/41 (61%) patients and ischemic but viable bowel in 16/41 (39%) patients. Increased unenhanced bowel-wall attenuation was the only CT finding significantly associated with bowel necrosis (p = 0.0002). This sign had 58% (95% CI, 37–78) sensitivity and 100% (95% CI, 79–100) specificity for necrosis. Interobserver agreement was fair (0.59; 95% CI, 0.37–0.82).

Conclusion

Increased unenhanced bowel-wall attenuation is specific for bowel necrosis and should lead to prompt surgery for bowel resection.

Key Points

• Increased unenhanced bowel-wall attenuation is the only sign specific for necrosis

• Decreased bowel-wall enhancement is not relevant for differentiating reversible ischemia from necrosis

• Preoperative knowledge of bowel necrosis is helpful to plan adequate surgery

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Title: Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction
Authors: Camille Rondenet
Ingrid Millet
Lucie Corno
Isabelle Boulay-Coletta
Patrice Taourel
Marc Zins
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5402-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction

Abstract

Objectives

Methods

Results

Conclusion

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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